Management of life-threatening uterine hemorrhage in a young patient with choriocarcinoma

Abstract

A 22-year-old primigravida who underwent medical abortion at 45 days of amenorrhea was diagnosed to have choriocarcinoma by histopathological examination after dilatation and curettage (D and C) for persistent bleeding per vaginum. Her serum β human chorionic gonadotropin values were less than 1 lakh and she was treated initially with methotrexate monotherapy elsewhere. She needed 10 units of packed cell transfusion for persistent hemorrhage and she was referred to our Institute because of persistent gestational trophoblastic neoplasia and intractable hemorrhage. She needed multiple transfusions and underwent laparotomy and bilateral internal iliac artery ligation with intrauterine packing as she had a severe bout of bleeding resulting in hemorrhagic shock. Post-operatively she was managed with chemotherapy employing EMACO (etoposide, methotrexate, actinomycin D, cyclophosphamide, vincristine/oncovine) and EMA (etoposide, methotrexate, actinomycin D) and thus her fertility was preserved.